Lung cancer is the leading cause of cancer-related mortality among non-AIDS-defining malignancies in people living with HIV (PLWH). Despite advancements in antiretroviral therapy, PLWH continue to face elevated risks for lung cancer due to various factors.To assess the prevalence and contributing risk factors of lung cancer among PLWH.A comprehensive literature review was conducted, identifying 1,787 records through a systematic search strategy. After removing duplicates and screening titles and abstracts, 180 full-text articles were evaluated for eligibility. Thirteen studies met the inclusion criteria, encompassing data from eight countries with a total sample size of 1,275,734 individuals. The quality of each study was assessed using the Newcastle-Ottawa Scale for cohort studies.The standardized incidence ratios (SIRs) for lung cancer among PLWH ranged from 0.70 to 4.8 across the included studies. Notably, studies from China reported higher SIRs of 4.8 (95% CI: 4.4–5.1) for males and 4.2 (95% CI: 3.5–5.0) for females. Key risk factors identified include higher smoking prevalence among PLWH, immunosuppression, and low CD4 counts. While some studies suggest a potential link between highly active antiretroviral therapy (HAART) and lung cancer development, the evidence remains inconclusive.Lung cancer incidence is two to three times higher in people living with HIV, driven by factors such as aging, smoking, and HIV-related immunosuppression, despite improvements in survival associated with HAART. Most cases are non-small-cell lung cancers, particularly adenocarcinoma, reflecting patterns in the general population, though the underlying mechanisms in the context of HIV remain unclear.Lung cancer remains a significant health concern for PLWH, with risk factors such as smoking, immunosuppression, and low CD4 counts playing pivotal roles. To mitigate this risk, it is crucial to implement smoking cessation programs, initiate early antiretroviral therapy, and maintain a high index of suspicion when evaluating respiratory symptoms.